Modelo para planificar e implantar la BPM en la Administración Pública: estudio del caso en la Administración Pública de la Comunidad Autónoma de Canarias

Programa de doctorado: Administración y dirección de empresas. La fecha de publicación es la fecha de lectura

[Glomerulonephritis and vasculitis as causes of arterial hypertension]

The various types of glomerulonephritis, including many forms of vasculitis, are responsible for about 15% of cases of end-stage renal disease (ESRD). Arterial hypertension represents a frequent finding in patients suffering from glomerulonephritis or vasculitis and hypertension also serves as an indicator for these severe types of diseases. In addition, there are symptoms and signs like hematuria, proteinuria and renal failure. Especially, rapidly progressive glomerulonephritis (RPGN) constitutes a medical emergency and must not be missed by treating physicians. This disease can either occur limited to the kidneys or in the context of a systemic inflammatory disorder, like a vasculitis. If left untreated, RPGN can lead to a necrotizing destruction of glomeruli causing irreversible kidney damage within several months or even weeks. With respect to the immunologically caused vasculitis, there are - depending upon the severity and type of organ involved - many clinical warning signs to be recognized, such as arterial hypertension, hemoptysis, arthalgias, muscle pain, palpable purpura, hematuria, proteinuria and renal failure. In addition, constitutional signs, such as fever and loss of body weight may occur concurrently. Investigations of glomerulonephritis or vasculitis must contain a careful and complete examination of family history and medications used by the respective patient. Thereafter, a thorough clinical examination must follow, including skin, joints and measurement of arterial blood pressure. In addition, a spectrum of laboratory analyses is required in blood, such as full blood screen, erythrocyte sedimentation rate, CRP, creatinine, urea and glucose, and in urine, including urinalysis looking for hematuria, red cell casts and proteinuria. Importantly, proteinuria needs to be quantified by the utilization of a random urine sample. Proteinuria > 3g/d is diagnostic for a glomerular damage. These basic tests are usually followed by more specialized analyses, such as a screening for infections, including search for HIV, hepatitis B or C and various bacteria, and for systemic inflammatory diseases, including tests for antibodies, such as ANA, anti-dsDNA, ANCA, anti-GBM and anti-CCP. In cases of membranous nephropathy, antibodies against phospholipase-A2-receptor need to be looked for. Depending upon the given clinical circumstances and the type of disease, a reasonable tumor screening must be performed, especially in cases of membranous and minimal-change nephropathy. Finally, radiological examinations will complete the initial work-up. In most cases, at least an ultrasound of the kidney is mandatory. Thereafter, in most cases a renal biopsy is required to establish a firm diagnosis to define all treatment options and their chance of success. The elimination of a specific cause for a given glomerulonephritis or vasculitis, such as an infection, a malignancy or a drug-related side-effect, remains the key principle in the management of these diseases. ACE-inhibitors, angiotensin receptor-blockers, aldosteron antagonists and renin-inhibitors remain the mainstay in the therapy of arterial hypertension with proteinuria. Only in cases of persistently high proteinuria, ACE-inhibitors and angiotensin receptor blockers can be prescribed in combination. Certain types of glomerulonephritis and essentially all forms of vasculitis require some form of more specific anti-inflammatory therapy. Respective immunosuppressive drug regimens contain traditionally medications, such as glucocorticoids (e. g. prednisone), cyclosporine A, mycophenolate mofetil, cyclophosphamide, and azathioprine. With respect to more severe forms of glomerulonephritis and vasculitis, the antibody rituximab represents a new and less toxic alternative to cyclophosphamide. Finally, in certain special cases, like Goodpasture's syndrome or severe ANCA-positive vasculitis, a plasma exchange will be useful and even required.

Beitrag zur Prozessstandardisierung in der Intralogistik

Ein dynamisches Umfeld erforderte die permanente Anpassung (intra-)logistischer Prozesse zur Aufrechterhaltung der Leistungs- und Wettbewerbsfähigkeit von Unternehmen. In der Standardisierung von Prozessen und in unternehmensübergreifenden Prozessmodellen wurden Schlüsselfaktoren für ein effizientes Geschäftsprozessmanagement gesehen, insbesondere in Netzwerken. In der Praxis fehlten wissenschaftlich fundierte und detaillierte Referenzprozessmodelle für die (Intra-)Logistik. Mit der Erforschung und Entwicklung eines Referenzprozessmodells und der prototypischen Realisierung einer Prozess-Workbench zur generischen Erstellung wandelbarer Prozessketten wurde ein Beitrag zur Prozessstandardisierung in der Logistik geleistet. Im Folgenden wird der beschrittene Lösungsweg dargestellt, der erstens aus der Entwicklung eines Metamodells für die Referenzmodellierung, zweitens aus dem empirischen Nachweis der Generierung eines Referenzprozessmodells aus „atomaren“ Elementen und drittens aus der Modellevaluation bestand.

Limited managerial attention and corporate aging

As firms have more assets in place, more of management’s limited attention is focused on managing assets in place rather than developing new growth options. Consequently, as firms grow older, they have fewer growth options and a lower ability to generate new growth options. This simple theory predicts that Tobin’s q falls with age. Further, competition in the product market is expected to slow down the decrease in Tobin’s q because it forces firms to look for alternative sources of rents. Similarly, greater competition in the labor market reduces the decrease in Tobin’s q with age because old firms are in a better position to hire employees that can help with innovation. In contrast, competition in the market for corporate control should accelerate the decline because it forces management to focus more on managing assets in place whose performance is more directly observable than on developing growth options where results may not be observable for some time. We find strong support for these predictions in tests using exogenous variation in competition.

Limited managerial attention and corporate aging

As firms have more assets in place, more of management’s limited attention is focused on managing assets in place rather than developing new growth options. Consequently, as firms grow older, they have fewer growth options and a lower ability to generate new growth options. This simple theory predicts that Tobin’s q falls with age. Further, competition in the product market is expected to slow down the decrease in Tobin’s q because it forces firms to look for alternative sources of rents. Similarly, greater competition in the labor market reduces the decrease in Tobin’s q with age because old firms are in a better position to hire employees that can help with innovation. In contrast, competition in the market for corporate control should accelerate the decline because it forces management to focus more on managing assets in place whose performance is more directly observable than on developing growth options where results may not be observable for some time. We find strong support for these predictions in tests using exogenous variation in competition

Managing team learning in a Spanish commercial bank

Purpose – The purpose of this paper is to analyze how team management affects team-learning activities. Design/methodology/approach – The authors empirically study 68 teams as they operate in the natural business context of a major Spanish bank. Quantitative research utilizing multiple regression analyses is used to test hypotheses. Findings – The leadership behaviour (consideration, initiation of structure) displayed by the team leader plays a key role in facilitating team learning. Team leader behaviour characterised by consideration and in particular by initiation of structure are both positively related to team-learning activities. Cross-training of team members also contributes to team-learning behaviour. Research limitations/implications – A specific setting may limit the generalizability of findings. Further research may accordingly investigate to what extent these results can be generalized to other settings or other aspects of team learning. Practical implications – The leadership style adopted by the team leader, as well as cross-training of members, affect team-learning activities. These results link leadership theory to collective learning in teams and organizations, and suggest ways leaders can contribute to improved learning. Originality/value – The study provides new insight into how management of teams facilitates team-learning activities. While consideration is somewhat related to team learning, initiation of structure as well as cross-training appear as key variables.

Modelado experimental de un sistema de e-Salud aplicado en cooperación al desarrollo

Los Objetivos de Desarrollo del Milenio comprometieron a los países con una nueva alianza mundial de alcanzar gradualmente una cobertura universal de los niveles mínimos de bienestar en los países en desarrollo (reducir la pobreza y el hambre y dar respuesta a problemas como la mala salud, las desigualdades de género, la falta de educación, el acceso a agua salubre y la degradación ambiental). Para dar continuidad a esta iniciativa, recientemente en septiembre de 2015, la ONU promulgó la declaración de los Objetivos de Desarrollo Sostenible. Los ODM sitúan la salud en el corazón del desarrollo y establecen un novedoso pacto mundial que vincula a los países desarrollados y los países en desarrollo por medio de obligaciones claras y recíprocas. En este sentido, diversos organismos de cooperación a través de sus programas de cooperación internacional, tratan de mejorar el acceso a la asistencia sanitaria, especialmente a la población vulnerable que vive en zonas rurales de países en desarrollo. Con el fin de ayudar a cumplir los ODM que apoyan los temas de salud en dicha población, estos organismos desarrollan proyectos que despliegan sistemas de e-salud. Las intervenciones se enfrentan a múltiples retos: condicionantes de los países en desarrollo, las necesidades y demandas de los sistemas sanitarios y la complejidad de implantar las TIC en entornos complejos y altamente dinámicos como son los países en desarrollo. Estos condicionantes ocasionan la mayoría de proyectos fallidos que terminan convirtiéndose en soluciones aisladas, que anteponen la tecnología a las necesidades de la población y no generan el impacto esperado en su desarrollo. En este contexto tuvo origen esta tesis doctoral, que persigue como objetivo analizar, planificar, diseñar, verificar y validar un marco arquitectónico de implantación de sistemas de e-salud en áreas rurales de países en desarrollo, que promueva el mejoramiento de la calidad de vida de la población vulnerable de estas regiones y la efectividad de las intervenciones de e-salud en el marco de proyectos de cooperación al desarrollo. Para lograrlo, tomé como punto de partida, diversas estrategias, modelos, metodologías de implantación de e-salud, modelos de gestión de proyectos propuestos por distintos organismos internacionales y propuse una instanciación de estos modelos a proyectos de implantación de sistemas de e-salud en países en desarrollo. Apliqué la metodología action research y los enfoques twin track, middle out y design thinking que me permitieron el refinamiento iterativo del modelo propuesto en la tesis doctoral mediante el trabajo de campo realizado en dos zonas rurales de países de Centroamérica: Jocotán (Guatemala) y San José de Cusmapa (Nicaragua). Como resultado obtuve un modelo experimental basado en cuatro componentes: un modelo de referencia tipo, un modelo conceptual de e-salud, los procesos de gestión y de implantación de sistemas de e-salud en países en desarrollo y una arquitectura de referencia. El modelo experimental resultante aporta herramientas importantes para el despliegue de sistemas de e-salud en países en desarrollo. Se ha propuesto un modelo de referencia que proporciona una visión holística del contexto del país en desarrollo donde se desarrollarán las intervenciones. Un modelo conceptual de e-salud que representa los principales conceptos involucrados en un sistema de e-salud. Los procesos ii- de gestión del proyecto y de implantación del sistema que proporcionan a los grupos de cooperación, herramientas para el análisis, diseño, desarrollo y despliegue de los sistemas de e-salud en áreas rurales de países en desarrollo. Y finalmente la arquitectura de referencia que sienta las bases para la aplicación de estos procesos a un contexto en particular. Las líneas futuras de trabajo sugieren extender el modelo a más casos de estudio que permitan su refinamiento y evaluar los futuros usos que pueden surgir de los sistemas de e-salud resultantes. ABSTRACT Millennium Development Goals (MDGs) committing the countries with a new global partnership to achieve universal coverage of minimum levels of well-being in Developing Countries (for addressing extreme poverty in its many dimensions-income poverty, hunger, disease, lack of adequate housing, and exclusion-while promoting gender equality, education, and environmental sustainability). From September 2015, these goals are replaces with Sustainable Development Goals (SDGs). The MDG place health at the heart of development and establish a novel global compact, linking developed and developing countries through clear, reciprocal obligations. Many public and private institutions promote international cooperation programs to support in achieving the MDGs. Some of these cooperation programs deal improving access to healthcare to poor people living in isolated areas from developing countries. In order to accomplish this goal organizations perform projects (interventions or cooperation projects) that deploy e-health systems in these zones. Nevertheless, this kind of projects face multiple challenges that dismiss the effectiveness of the projects results. In particular, cooperation teams face issues such as constraints in developing countries, lack of electrical and ICT infrastructure, scarce transport, extreme climate conditions, lack ICT capacity, lack of access to healthcare and inefficient delivery methods, etc. Hence, these issues increase the complexity of implementing e-health in developing countries and then causes the most projects fail. In other words, the solutions do not meet population needs and do not generate the expected impact on development. This context is the starting point of this doctoral thesis, which deals with analysing, planning, designing, testing and validating an architectural framework in order to implement e-health systems in rural areas from developing countries, promote development of the population in these regions, and thus improve the impact of interventions of development cooperation projects. To achieve this goal, I took as a starting point the strategies, models, e-health implementation methodologies and projects management models proposed by various international agencies. Then I proposed an instantiation of these models to manage the intervention and implement e-health systems in developing countries. I applied the action research methodology and the approaches twin track, middle out and design thinking which allowed me the iterative refinement of the model proposed in this doctoral thesis. The proposed framework was validated by running two cases studies in rural areas of Central America: Jocotán (Guatemala) and San José de Cusmapa (Nicaragua). As a result, I obtained an experimental model based on four components: a Type reference model, an e-health conceptual model, both process management and implementation e-health systems in developing countries and a reference architecture. The resulting experimental model provides important tools for the deployment of e-health systems in developing countries. The model become as reference model that provides a holistic view of the developing countries context where the interventions will be running. The conceptual model of e-health represents the main concepts involved into an e-health system. The project management and implementation processes of the iv- system provide to the cooperation teams with tools for analysing, designing, developing and deploying e-health systems in rural areas from developing countries. Finally, the reference architecture provides the basis for the implementation of these processes into a particular context. The future research suggest the extension the model to other cases studies in order to refine and evaluate the viability the model.

Loss of speciation rate will impoverish future diversity

Human activities have greatly reduced the amount of the earth's area available to wild species. As the area they have left declines, so will their rates of speciation. This loss of speciation will occur for two reasons: species with larger geographical ranges speciate faster; and loss of area drives up extinction rates, thus reducing the number of species available for speciation. Theory predicts steady states in species diversity, and fossils suggest that these have typified life for most of the past 500 million years. Modern and fossil evidence indicates that, at the scale of the whole earth and its major biogeographical provinces, those steady states respond linearly, or nearly so, to available area. Hence, a loss of x% of area will produce a loss of about x% of species. Local samples of habitats merely echo the diversity available in the whole province of which they are a part. So, conservation tactics that rely on remnant patches to preserve diversity cannot succeed for long. Instead, diversity will decay to a depauperate steady state in two phases. The first will involve deterministic extinctions, reflecting the loss of all areas in which a species can ordinarily sustain its demographics. The second will be stochastic, reflecting accidents brought on by global warming, new diseases, and commingling the species of the separate bio-provinces. A new kind of conservation effort, reconciliation ecology, can avoid this decay. Reconciliation ecology discovers how to modify and diversify anthropogenic habitats so that they harbor a wide variety of species. It develops management techniques that allow humans to share their geographical range with wild species.

Colaboração e cooperação entre sistemas produtivos dispersos de empresas virtuais.

No mercado global e digital, as empresas são desafiadas a encontrar caminhos inovadores para atender o aumento da pressão -competitiva. A competição é uma das formas de interação das organizações, além da colaboração e da cooperação. A cooperação e a colaboração apresentam formas de produzir conjuntamente aumentando o potencial de atendimento das empresas. Os desafios mais encontrados no mercado são: reduzir os custos, sempre assegurar qualidade e personalizar os produtos e serviços. Um fenômeno de negócios comum hoje é a terceirização da manufatura e da logística para fornecedores domésticos e estrangeiros e provedores de serviços. Essa terceirização provoca, intrinsecamente, um espalhamento geográfico da produção em novos centros que oferecem vantagens nos recursos energéticos, matérias primas e centros de produção de conhecimento. Essa terceirização pode ser realizada também nas formas de colaboração e cooperação. Para isso, as empresas necessitam estabelecer uma forma de confiança entre si. No conceito de empresa virtual, a confiança é amplamente discutida para atingir uma colaboração e/ou cooperação entre empresas. O objetivo deste trabalho é propor e modelar uma ferramenta que atenda as necessidades das empresas para colaboração e/ou cooperação entre elas, considerando suas necessidades de confiança. As empresas aqui são vistas como sistemas produtivos, com suas camadas de gerenciamento de negócios, de acordo com o padrão ANSI/ISA 95. Além disso, um tipo de interpretação da rede de Petri, chamada de rede de Petri produtiva é introduzida como ferramenta para descrever o processo produtivo realizado pelas empresas na forma de workflow. A modelagem dessa arquitetura do sistema produtivo utiliza técnicas de sistemas distribuídos, como a arquitetura orientada a serviços. Além disso, um dos enfoques é das necessidades para o desenvolvimento de novos produtos, que envolve o desafio de personalização. Testes foram realizados para avaliar a proposta de workflow com pessoas de diferentes níveis de conhecimento sobre os processos, sejam de manufatura, sejam de outras áreas. Já a arquitetura proposta foi submetida a um estudo analítico das hipóteses levantadas no ambiente colaborativo.

Surface and Groundwater Environmental Policy Compliance at the Adams County Regional Park and Fairgrounds

The Adams County Regional Park and Fairgrounds must comply with environmental policies related to surface water and groundwater protection. This paper assesses various methods which have proven to be effective in the reduction of nutrients and other contaminants found in surface and groundwater at comparable livestock-based venues. Data was gathered from other facilities in order to identify specific compliance alternatives and evaluate management options. Empirical research, coupled with GIS mapping technology yielded explicit water quality management recommendations for the Adams County Regional Park and Fairgrounds. The outcome of this research and mapping exercise include twelve management recommendations and two site-specific locations for structural BMPs designed to better control water pollution at the Adams County Regional Park and Fairgrounds.

Gestão de processos de negócio: uma abordagem ao processo de acreditação dos cursos no Gabinete de Avaliação da Qualidade da Escola Superior de Desporto de Rio Maior

Atualmente, as instituições do ensino superior, onde se inclui a Escola Superior de Desporto de Rio Maior do Instituto Politécnico de Santarém, deparam-se com várias questões e desafios relacionados com a sua acreditação e a dos seus ciclos de estudo, e consequentemente, com a melhoria da qualidade do seu desempenho e o acesso a financiamento. Esta realidade exige novas abordagens e o aumento do nível de exigência a todos os intervenientes que contribuem para a qualidade do serviço prestado. No sentido de dar resposta a estes desafios, o Gabinete de Avaliação e Qualidade tem desenvolvido iniciativas e abordagens das quais o presente trabalho é um exemplo. Com este trabalho pretendeu-se, a partir de numa abordagem de Business Process Management, demonstrar a viabilidade e operacionalidade da utilização de uma ferramenta de Business Process Management System neste contexto. Para tal, realizou-se a modelação do processo de avaliação e acreditação desenvolvido pela Agência de Avaliação e Acreditação do Ensino Superior, através da utilização do Business Process Model and Notation. Esta proposta permitiu modelar os processos na instituição, demonstrando a utilização de uma abordagem Business Process Management numa organização desta natureza, com o objetivo de promover a sua melhoria.

Gestão de processos de negócio em organizações desportivas: um estudo de caso no Comitée Européen de Rink-Hockey

A Gestão de Processos de Negócio (BPM – Business Process Management) é uma abordagem que tem como objetivo melhorar a eficiência nas organizações, através da gestão dos processos, em que se realiza a sua modelação, organização e otimização de uma forma iterativa e contínua. O BPM permite suportar os processos de negócio, através da utilização de métodos, técnicas e software para projetar, representar e analisar processos organizacionais que envolvem, pessoas, organizações, aplicações, documentos e outras fontes de informação (Aalst, Hofstede, & Weske, 2003). Neste estudo é utilizado um Business Process Management System (BPMS) para realizar a modelação dos processos do Comité Européen de Rink-Hockey (CERH), para a inscrição de equipas e atletas, nos eventos realizados sob a responsabilidade deste comité. A modelação é realizada através da utilização do Business Process Model and Notation (BPMN). A utilização do BPMS foi realizada considerando as seguintes etapas: (1) desenho do processo; (2) definição do processo; (3) desenvolvimento do processo e (4) administração e utilização de processos. Pretendeu-se, demonstrar a viabilidade e operacionalidade na utilização de uma ferramenta BPMS open-source, numa abordagem BPM, na modelação e implementação de processos, em detrimento de soluções proprietárias de custo elevado. O critério adotado para a seleção da ferramenta baseia-se na análise de relatórios sobre BPMS, que nos permitiu identificar e sustentar a solução adotada (Hill, Cantara, & Kerremans, 2009; Ovum, 2010; Richardson, Moore, Clair, & Vitti, 2010; Sinur & Hill, 2010). O resultado foi o desenvolvimento dos processos na organização, com a sua modelação em BPMN e implementação num BPMS, onde podemos comprovar a abordagem BPM numa organização desportiva.

Pages from an old volume of life ; a collection of essays, 1857-1881,

Bread and the newspaper.--My hunt after "the captain."--The inevitable trail.--The physiology of walking.--The seasons.--The human body and it's management.--Cinders from the ashes.--Mechanism in thought and morals.--The physiology of versification.--Crime and automatism.--Jonathan Edwards.--The pulpit and the pew.